Management of Xylazine-Induced Soft-Tissue Necrosis: A Review of 20 Cases.

IF 2.6 2区医学 Q1 ORTHOPEDICS

Journal of the American Academy of Orthopaedic Surgeons Pub Date : 2024-08-23 DOI:10.5435/JAAOS-D-24-00125

Helene Retrouvey, Maximilian A Meyer, Kyros Ipaktchi, Andrew Maertens, Matthew Folchert, Alexander Lauder

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引用次数: 0

Abstract

Purpose: The illicit injection of xylazine has recently been designated as an emerging public health threat. The use of this drug is associated with devastating soft-tissue necrosis that may lead to limb amputation. This study aimed to (1) report cases of soft-tissue injury from xylazine and (2) describe a staging and management algorithm for wounds related to xylazine use.

Methods: A retrospective review was conducted to identify patients treated for xylazine-related soft-tissue necrosis at a trauma center. Clinical cases, treatment strategy, and available outcomes were presented. In addition, a comprehensive literature search was conducted using the keywords "xylazine" and "soft tissue."

Results: The management of seven patients with xylazine-related upper extremity soft-tissue necrosis was included, in addition to summarizing findings of five studies reporting on 13 additional cases. These cases were managed with local wound care (2 patients), soft-tissue reconstruction (4 patient), osseous reconstruction (1 patient), and limb amputation (10 patients).

Discussion: Acute treatment of xylazine-related soft-tissue necrosis is ideal to minimize morbidity and prevent limb loss. Management strategies of these wounds should be based on the depth of tissue involvement. Superficial ulceration involving the skin and subcutaneous tissue (Stage 1) should be managed with local wound care. Deeper ulceration involving tendons and/or muscle (Stage 2) requires surgical débridement and soft-tissue reconstruction. Deeper ulceration involving bone (Stage 3) requires osseous débridement and reconstruction. Finally, when all tissues in the extremity are involved (Stage 4), amputation is often necessary.

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对赛拉嗪引起的软组织坏死的处理：20 例病例回顾

目的：非法注射异丙嗪最近被定为一种新出现的公共健康威胁。使用这种药物会造成破坏性软组织坏死，可能导致截肢。本研究旨在：(1) 报告因使用甲苯噻嗪而导致软组织损伤的病例；(2) 描述与使用甲苯噻嗪有关的伤口的分期和管理算法：方法：我们进行了一项回顾性研究，以确定在一家创伤中心接受过与甲苯噻嗪相关的软组织坏死治疗的患者。介绍了临床病例、治疗策略和现有结果。此外，还以 "甲苯噻嗪 "和 "软组织 "为关键词进行了全面的文献检索：除了总结五项研究对另外 13 例病例的报告结果外，还纳入了对七例与二甲苯嗪相关的上肢软组织坏死患者的治疗方法。这些病例的治疗方法包括局部伤口护理（2 例患者）、软组织重建（4 例患者）、骨重建（1 例患者）和截肢（10 例患者）：讨论：木乃伊相关软组织坏死的急性治疗是降低发病率和防止肢体缺失的理想方法。这些伤口的处理策略应基于组织受累的深度。涉及皮肤和皮下组织的浅表溃疡（第 1 阶段）应通过局部伤口护理进行处理。涉及肌腱和/或肌肉的较深溃疡（第 2 阶段）需要进行手术清创和软组织重建。涉及骨骼的较深溃疡（第 3 阶段）需要进行骨清创和重建。最后，当肢体的所有组织都受累时（第 4 阶段），通常需要截肢。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Academy of Orthopaedic Surgeons 医学-整形外科

CiteScore

6.10

自引率

6.20%

发文量

529

审稿时长

4-8 weeks

期刊介绍： The Journal of the American Academy of Orthopaedic Surgeons was established in the fall of 1993 by the Academy in response to its membership’s demand for a clinical review journal. Two issues were published the first year, followed by six issues yearly from 1994 through 2004. In September 2005, JAAOS began publishing monthly issues. Each issue includes richly illustrated peer-reviewed articles focused on clinical diagnosis and management. Special features in each issue provide commentary on developments in pharmacotherapeutics, materials and techniques, and computer applications.